**Pacemaker & ICD Implantation: Comprehensive CPT Coding Guide**

Introduction

Pacemaker and implantable cardioverter-defibrillator (ICD) procedures are commonly performed to manage arrhythmias and other cardiac conditions. Proper CPT coding ensures accurate reimbursement and prevents denials due to bundling or incorrect modifier use. This guide covers key CPT codes for pacemaker and ICD implantation, lead revisions, and generator replacements, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.

Understanding Pacemaker & ICD Coding

  • Pacemaker implantation – Used to regulate slow heart rhythms (bradycardia).
  • ICD implantation – Used for patients at risk of life-threatening arrhythmias.
  • Lead revision or extraction – Performed when pacemaker/ICD leads need adjustment or removal.
  • Generator replacement – Needed when the battery of a pacemaker or ICD depletes.

CPT Codes for Pacemaker & ICD Procedures

Pacemaker Implantation CPT Codes

  • 33206 – Insertion of permanent pacemaker, single chamber.
  • 33207 – Insertion of permanent pacemaker, dual chamber.
  • 33208 – Insertion of permanent pacemaker, multiple leads.

ICD Implantation CPT Codes

  • 33249 – Insertion or replacement of ICD, single or dual chamber.
  • 33262 – Replacement of ICD pulse generator, single chamber.
  • 33263 – Replacement of ICD pulse generator, dual chamber.
  • 33264 – Replacement of ICD pulse generator, multiple leads.

Lead Revision, Removal, and Repair CPT Codes

  • 33210 – Temporary transvenous pacemaker insertion.
  • 33215 – Repositioning of pacemaker or ICD lead.
  • 33216 – Insertion of single transvenous electrode for pacing.
  • 33217 – Insertion of dual transvenous electrodes for pacing.
  • 33218 – Repair of single pacemaker/ICD lead.
  • 33220 – Repair of two pacemaker/ICD leads.
  • 33222 – Relocation of pacemaker pocket.
  • 33233 – Removal of pacemaker pulse generator.
  • 33235 – Removal of ICD pulse generator.
  • 33244 – Removal of single transvenous pacemaker/ICD lead.
  • 33249 – Removal of two or more transvenous pacemaker/ICD leads.

Billing Guidelines & Modifier Usage

  • Common Modifiers:

    • -26 – Professional component (physician’s interpretation).
    • -TC – Technical component (equipment, technician use).
    • -59 – Distinct procedural service (if multiple interventions are performed).

  • Bundling Considerations:

    • Lead repositioning (33215) is often bundled with pacemaker or ICD insertion codes.
    • Pulse generator replacements (33262-33264) should not be billed with lead removal codes (33244-33249) unless separate services are performed.

Common Denials & How to Avoid Them

  • Medical Necessity Denials: Ensure documentation includes diagnoses such as symptomatic bradycardia, AV block, or ventricular tachycardia.
  • Bundling Issues: Verify National Correct Coding Initiative (NCCI) edits to determine if procedures should be reported separately.
  • Modifier Use Issues: Append -59 or -XU modifiers correctly when multiple procedures are performed on the same day.

Final CPT Code Table: Descriptions & RVUs

CPT Code Description RVU
33206 Insertion of permanent pacemaker, single chamber 12.85
33207 Insertion of permanent pacemaker, dual chamber 15.20
33208 Insertion of permanent pacemaker, multiple leads 17.50
33249 Insertion or replacement of ICD, single or dual chamber 20.30
33262 Replacement of ICD pulse generator, single chamber 13.90
33263 Replacement of ICD pulse generator, dual chamber 15.75
33264 Replacement of ICD pulse generator, multiple leads 17.80
33210 Temporary transvenous pacemaker insertion 8.40
33215 Repositioning of pacemaker or ICD lead 6.90
33216 Insertion of single transvenous electrode for pacing 9.25
33217 Insertion of dual transvenous electrodes for pacing 11.30
33218 Repair of single pacemaker/ICD lead 7.50
33220 Repair of two pacemaker/ICD leads 9.85
33222 Relocation of pacemaker pocket 10.40
33233 Removal of pacemaker pulse generator 8.90
33235 Removal of ICD pulse generator 9.70
33244 Removal of single transvenous pacemaker/ICD lead 10.25
33249 Removal of two or more transvenous pacemaker/ICD leads 13.10

Conclusion

Accurate CPT coding for pacemaker and ICD implantation procedures is essential for maximizing reimbursement and preventing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.

If this guide was useful, check out our other cardiology CPT coding guides on echocardiography, cardiac catheterization, and electrophysiology studies!